Abstract
Background: Coronavirus disease-2019 (COVID-19) has a deleterious effect on several systems, including the cardiovascular system. We aim to systematically explore the association of COVID-19 severity and mortality rate with the history of cardiovascular diseases and/or other comorbidities and cardiac injury laboratory markers.
Methods: The standardized mean difference (SMD) or odds ratio (OR) and 95% confidence intervals (CIs) were applied to estimate pooled results from the 56 studies. The prognostic performance of cardiac markers for predicting adverse outcomes and to select the best cutoff threshold was estimated by receiver operating characteristic curve analysis. Decision tree analysis by combining cardiac markers with demographic and clinical features was applied to predict mortality and severity in patients with COVID-19.
Results: A meta-analysis of 17 794 patients showed patients with high cardiac troponin I (OR = 5.22, 95% CI = 3.73-7.31, P < .001) and aspartate aminotransferase (AST) levels (OR = 3.64, 95% CI = 2.84-4.66, P < .001) were more likely to develop adverse outcomes. High troponin I more than 13.75 ng/L combined with either advanced age more than 60 years or elevated AST level more than 27.72 U/L was the best model to predict poor outcomes.
Conclusions: COVID-19 severity and mortality are complicated by myocardial injury. Assessment of cardiac injury biomarkers may improve the identification of those patients at the highest risk and potentially lead to improved therapeutic approaches.
Keywords: COVID-19; SARS-CoV-2; cardiac injury; cardiac markers; meta-analysis; outcome.
【저자키워드】 COVID-19, Meta-analysis, SARS-CoV-2, outcome, Cardiac markers, cardiac injury, 【초록키워드】 coronavirus disease, Meta-analysis, coronavirus, Biomarker, Mortality, severity, COVID-19 severity, Comorbidity, risk, cardiovascular disease, cardiovascular diseases, cardiovascular system, outcome, Cardiac markers, adverse outcomes, Laboratory, coronavirus disease-2019, cardiac troponin, adverse outcome, cardiac injury, outcomes, myocardial injury, Patient, cardiac marker, Aspartate aminotransferase, AST, mortality rate, Decision tree, troponin I, prognostic, assessment, threshold, characteristic, predict, clinical feature, association, Analysis, Injury, Deleterious, Odds ratio, lead, best, receiver operating characteristic, standardized mean difference, 95% CI, 95% confidence interval, therapeutic approaches, advanced age, aspartate, Cutoff, SMD, IMPROVE, highest, develop, elevated, applied, CIs, patients with COVID-19, 【제목키워드】 Biomarker, severity, Comorbidity, meta-regression, Decision tree, Analysis, Injury, increased mortality,